The Supreme Court has ruled favorably on the legality of the Affordable Care Act. Actually, despite its name, the Act has more to do with extending and attempting to improve private health insurance coverage than it does with improving care or reducing its cost.

Unfortunately for us, the effort to improve our health care system has remained within bounds set by the needs of private health care providers and insurers. As President Obama made clear from the start of his push for health care reform, there would be no consideration of a universal system.

Critics of such a universal system are always quick to argue that only market forces driven by the private pursuit of profit can ensure an efficient health care system. Of course, in determining whether this is true, we need to recognize that efficiency is a complex term and that our health care system, like all systems, produces multiple outcomes. The most obvious ones are private profit as well as the quality and cost of the relevant health care.

In terms of private profit there can be no doubt that our health care system functions well. However, the story is quite different if we evaluate it in terms of quality and cost. The fact that we continue to embrace a private health care system makes clear which measures of efficiency are considered most important and by whom.

The following map shows the countries, colored green, that have adopted a universal health care system.

What’s astonishing is how cleanly the green and grey separate the developed nations from the developing, almost categorically. Nearly the entire developed world is colored, from Europe to the Asian powerhouses to South America’s southern cone to the Anglophone states of Australia, New Zealand, and Canada. The only developed outliers are a few still-troubled Balkan states, the Soviet-style autocracy of Belarus, and the U.S. of A., the richest nation in the world.

The handful of developing countries that provide universal access to health care include oil-rich Saudi Arabia and Oman, Latin success story Costa Rica, Kyrgyzstan, and, famously, Cuba, among a few others. A number of countries have attempted universal health care but failed, such as South Africa, which maintains a notoriously inefficient and troubled public plan to complement the private plans popular among middle- and upper-class citizens…

That brings us to another way that America is a big outlier on health care. The grey countries on this map tend to spend significantly less per capita on health care than do the green countries — except for the U.S., where the government spends way more on health care per person than do most countries with free, universal health care. This is also true of health care costs as a share of national GDP — in other words, how much of a country’s money goes into health care.

The OECD just published a major study on the health care systems of its 34 member nations. It found that:

Health spending accounted for 17.6% of GDP in the United States in 2010, down slightly from 2009 (17.7%) and by far the highest share in the OECD, and a full eight percentage points higher than the OECD average of 9.5%. Following the United States were the Netherlands (at 12.0% of GDP), and France and Germany (both at 11.6% of GDP).

The United States spent 8,233 USD on health per capita in 2010, two-and-a-half times more than the OECD average of 3,268 USD (adjusted for purchasing power parity). Following the United States were Norway and Switzerland which spent over 5,250 USD per capita. Americans spent more than twice as much as relatively rich European countries such as France, Sweden and the United Kingdom.

What does all of this mean in terms of health outcomes? According to the OECD report:

Most OECD countries have enjoyed large gains in life expectancy over the past decades. In the United States, life expectancy at birth increased by almost 9 years between 1960 and 2010, but this is less than the increase of over 15 years in Japan and over 11 years on average in OECD countries. As a result, while life expectancy in the United States used to be 1½ year above the OECD average in 1960, it is now, at 78.7 years in 2010, more than one year below the average of 79.8 years. Japan, Switzerland, Italy and Spain are the OECD countries with the highest life expectancy, exceeding 82 years.

One possible explanation for this lagging performance, highlighted in an earlier OECD report, is that the U.S. ranked 26th in terms of the number of practicing physicians relative to its population, 29th in terms of the number of doctor consultations per capita, 29th in terms of the number of hospital beds per capita, and 29th in terms of the average length of hospital stay. At the same time, the “U.S. health system does do a lot of interventions… it has a lot of expensive diagnostic equipment, which it uses a lot. And it does a lot of elective surgery — the sort of activities where it is not always clear cut about whether a particular intervention is necessary or not.”

Private health care providers and insurers are clear about how they measure health care efficiency. And as long as we rely on them to set the terms of the debate we will continue to suffer the consequences.

In a previous post I discussed how the U.S. became more religious in the 1950s, in part in response to its the Cold War enemies (atheist communists). In fact, the U.S. is among the most religious countries in the world. Using data from the International Social Survey Programme, Sociologist Tom Smith paints wildly different religious portraits of 28 nations (full text).

When asked whether they “know that God really exists and… have no doubt about it,” 61% of Americans say “yes.” Of the 28 nations studied, only four were more likely to say “yes” to this question: Poland, Israel, Chile, and the Philippines. Here’s how we look compared to similar countries:

Here’s all 28 in rank order (borrowed from LiveScience). Notice how wide the divergence is. In Japan, the least religious country according to this measure, only 4% say they have no doubt God exists. In The Philippines, 84% have no doubt.

% Have No Doubt God Exists:

Japan: 4.3 percent

East Germany: 7.8 percent

Sweden: 10.2

Czech Republic: 11.1

Denmark: 13.0

Norway: 14.8

France: 15.5

Great Britain: 16.8

The Netherlands: 21.2

Austria: 21.4

Latvia: 21.7

Hungary: 23.5

Slovenia: 23.6

Australia: 24.9

Switzerland: 25.0

New Zealand: 26.4

West Germany: 26.7

Russia: 30.5

Spain: 38.4

Slovakia: 39.2

Italy: 41.0

Ireland: 43.2

Northern Ireland: 45.6

Portugal: 50.9

Cyprus: 59.0

United States: 60.6

Poland: 62.0

Israel: 65.5

Chile: 79.4

The Philippines: 83.6

Americans are also particularly likely to believe in a “personal God,” one who is closely attentive to the lives of each and every person.

Quite interestingly, the U.S. is in the minority in that Americans tend to become increasingly religious as they age. In most countries, people become less religious over time. This graph (confusingly labeled), shows changes in DISbelief over the life course. The U.S. is the only country among these in which disbelief declines:

Lifetime Change in Religiosity (from increase in disbelief to increase in belief):

The Netherlands: -14.0

Spain: -12.4

Australia: -12.0

France: -11.3

Norway: -11.0

Great Britain: -10.1

Switzerland: -8.2

Germany (East): -6.9

Denmark: -6.1

Czech Republic: -5.5

Sweden: -5.5

Germany (West): -5.4

New Zealand: -4.0

Italy: -2.7

Poland: -1.8

Japan: -1.5

Ireland: -0.9

Chile: +0.1

Cyprus: +0.2

Portugal: +0.6

The Philippines: +0.8

Hungary: +1.0

Northern Ireland: +1.0

United States: +1.4

Israel: +2.6

Slovakia: +5.6

Slovenia: +8.5

Latvia: +11.9

Russia: +16.0

Rates of atheism — a strong disbelief in God — also vary tremendously. East Germany is the most atheist, with more than half of citizens claiming disbelief. The country is a stark contrast to the atheist among them, Poland and the U.S. (only 3% atheist), Chile and Cyprus (2%), and The Phillipines (1%).

% Atheist:

East Germany: 52.1

Czech Republic: 39.9

France: 23.3

The Netherlands: 19.7

Sweden: 19.3

Latvia: 18.3

Great Britain: 18.0

Denmark: 17.9

Norway: 17.4

Australia: 15.9

Hungary: 15.2

Slovenia: 13.2

New Zealand: 12.6

Slovakia: 11.7

West Germany: 10.3

Spain: 9.7

Switzerland: 9.3

Austria: 9.2

Japan: 8.7

Russia: 6.8

Northern Ireland: 6.6

Israel: 6.0

Italy: 5.9

Portugal: 5.1

Ireland: 5.0

Poland: 3.3

United States: 3.0

Chile: 1.9

Cyprus: 1.9

The Philippines: 0.7

As a post-9/11 American watching another election cycle, I can’t help but notice how so much of our rhetoric revolves — sometimes overtly and sometimes not — around people who are the wrong religion. Notably, Muslims. And yet, the U.S. and many Muslim countries are alike in being strongly religious, at least in comparison to the many strongly secular countries.

This is odd because stands in contrast to recent data on American attitudes. Within the U.S., people express much less tolerance for atheists than they do Muslims (homosexuals, African Americans, and immigrants). Weirdly, we think we have more in common with more secular nations like Great Britain than we do with countries like Pakistan or Saudi Arabia. In certain ways, the opposite might be true.

How does the U.S. compare to other developed countries on measures of social justice? According to the New York Times, not very well. The visual below compares countries’ poverty rates, poverty prevention measures, income inequality, spending on pre-primary education, and citizen health. The “overall” rating is on the far left and the U.S. ranks 27th out of 31.

As we enter the last frenzied days of Christmas shopping, Dmitriy T.M. thought it was worth looking at international comparisons in spending on the holiday. The Economist posted a graph based on Gallup polls and other data sources about how much individuals in various countries in Europe, plus the U.S. and South Africa, plan to spend on Christmas shopping this year, plotted against national GDP. Overall, Christmas spending correlates with national wealth, with the Netherlands being a noticeable outlier (spending less than we’d expect) and Luxembourg in a spending league of its own:

Does American prosperity translate into long retirements? Not compared to other developed countries in the world. Flowing Data borrowed OECD numbers on life expectancy and age of retirement to calculate the average number of years in retirement for men and women across many different countries. The portion of each bar with the line is the average number of years working, while the non-lined portion represents years in retirement.

Largely because of life expectancy, women enjoy more years than men in all states except Turkey, but the number of years varies quite tremendously, from an average of zero years for men in Mexico, to an average of 26 years for women in Austria and Italy. The United States is way down on this list, not doing so well relatively after all.

I am trying to re-enter society after several days being sick, so I’m going with something short and simple today. Eden H. sent in this chart, found at Business Insider, that compares hourly minimum wages in a number of European countries to the U.S.:

The European data are available from Eurostat (though note they report minimum wages in terms of Euros per month, not hour, so the data was converted for the chart).

Katrin drew our attention to the Christmas character of the Christkind, found in regions as diverse as Austria, Italy, Hungary, Slovakia, the Czech Rebublic, Croatia, Slovenia, Germany, Liechtenstein, Switzerland and, according to Wikipedia, “…parts of Hispanic America, in certain areas of southern Brazil and in the Acadiana region of Louisiana.”

The Christkind was introduced by the German Protestant priest Martin Luther (1483-1546). At the time, tradition held that gifts were given by St. Nicholas. Protestants, however, didn’t acknowledge saints, so they needed an alternative mythological gift giver. The Christkind was originally depicted as baby Jesus, but in many places today is instead an angelic blond child or adult woman.

In Nuremberg, Germany, a Christkind is chosen every two years in a pageant reminiscent of American beauty pageants (source). This year the Christkind is Rebekka Volland (source):